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Multidisciplinary Approach Reduces Breast Cancer Deaths

 |  By jsimmons@healthleadersmedia.com  
   September 27, 2010

A breast cancer screening program in Norway—which made mammographic screening available to women between the ages of 50 and 69—led to a smaller decrease in deaths by breast cancer than anticipated, according to a study led by Harvard School of Public Health (HSPH) researchers in the latest New England Journal of Medicine.

"The observed reduction in death from breast cancer after introduction of the mammography screening program was far less than we expected," said lead author Mette Kalager, a visiting scientist at HSPH and a surgeon at Oslo University Hospital in Norway. "The results showed that other factors—such as enhanced breast cancer awareness and improved treatment—actually had a greater effect on reducing mortality from breast cancer."

In Norway, each county is required to establish multidisciplinary breast cancer management teams—made up of specialized radiologists, radiologic technologists, pathologists, surgeons, oncologists and nurses—that women enroll in before entering the national screening program.

Among women older than 70 years—who were treated by multidisciplinary teams alone and not invited to undergo mammography screening—the study found an 8% reduction in death from breast cancer. Among women ages 50 to 69 who did undergo mammography screening, a 10% decrease in breast cancer deaths was reported.

"This can be explained by treatment of multidisciplinary teams...that manage the care of the patients," the authors said. "The 10% reduction we found among women aged 50 to 69 years old being invited to mammography screening can be attributed to both the mammograms and management by multidisciplinary teams."

The authors analyzed data from 40,075 women diagnosed with breast cancer who participated in the Norwegian breast cancer screening program. With the program, which began in 1996, the researchers compared the rates of death from breast cancer among four groups of women.

The one group of women (ages 50-69) lived from 1996 through 2005 in Norwegian counties where mammographic screening was provided every two years. A second group represented women with breast cancer in counties where screening wasn't available. The remainder study population consisted of two historical-comparison groups from 1986 through 1995 that mirrored the current groups.

The rate of death was reduced by 7.2 deaths per 100,000 person-years in the screening group (when compared with the historical screening group) and by 4.8 deaths per 100,000 person years in the nonscreening group. The difference in the reduction in mortality between the current and historical groups attributed to screening alone was 2.4 deaths per 100,000 person-years—or about a third of the total reduction of 7.2 deaths.

Only a third of the mortality reduction in the 20-year period was associated with the screening program, the researchers said. The remaining two-thirds can be linked to enhanced breast cancer awareness, [and] improved diagnostic and treatment for breast cancer," Kalager said.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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